Multimorbidity and the risk of post-tuberculosis lung disease: a systematic review and meta-analysis.

INTRODUCTION

Post-tuberculosis lung disease (PTLD), a chronic respiratory syndrome affecting approximately half of tuberculosis (TB) survivors, is an emerging public health threat in low- and middle-income countries (LMICs). Multimorbidity, defined as two or more coexisting chronic health conditions, is also rising in LMICs. This systematic review and meta-analysis examines associations between multimorbidity or individual comorbidities and PTLD.

METHODS

Medline, EMBASE, Web of Science, Global Health and Scopus databases up to 7 March 2024 were searched and studies in LMICs assessing PTLD and either a single comorbidity or multimorbidity were included. Summary data were extracted independently by two reviewers. Random effects meta-analyses were performed where sufficient comparable data were reported. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies-of Exposure and certainty of evidence for meta-analysable associations was assessed using Grading of Recommendations Assessment, Development and Evaluation. Study protocol was registered with PROSPERO (CRD42024552486).

RESULTS

41 papers, from 10 321 screened, were included. None analysed multimorbidity. PTLD measurement tools varied widely. Meta-analysis of 10 of 24 papers analysing the association between spirometry-defined PTLD and HIV status found reduced odds of PTLD in people living with HIV (OR 0.68, 95% CI 0.52 to 0.89). 15 papers reported on diabetes and showed inconsistent associations; meta-analysis of three papers yielded an OR of 1.65 (95% CI 0.96 to 2.84). Adults with undernutrition had increased odds of abnormal spirometry following TB on meta-analysis of three studies (OR 1.99, 95% CI 1.02 to 3.87). Evidence for other comorbidities was limited and inconclusive. Overall, 24/41 (58.5%) of included studies were at high risk of bias and certainty of evidence for meta-analysed associations was very low.

CONCLUSION

PTLD may be more common among adults who are HIV-negative or undernourished, but the evidence is very uncertain. The absence of dedicated multimorbidity studies and inconsistencies in defining PTLD highlight the need for prospective studies evaluating comorbidities in relation to PTLD.

PROSPERO REGISTRATION NUMBER

CRD42024552486.

© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.